Rose-trellis periosteal release in oral mucosal advancement flaps in pigs.

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p=0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.

Review of the Intercollegiate Surgical Curriculum Programme for oral and maxillofacial surgery aesthetics: are we underselling ourselves?

Aesthetic facial surgery is considered to be within the remit of the maxillofacial surgeon but this is not reflected currently in the trainees' curriculum. In contrast, the plastic surgery curriculum demands detailed training in facial aesthetics. In this paper we have compared the UK OMFS, plastics, and otolaryngology curricula, and used the feedback of trainees to suggest a new aesthetics curriculum. Our method was based on the first three steps of Kern's 1998 six-step model of curricula development: identification of problems, assessment of need, and goals or objectives. The cosmetic certification criterion of the Royal College of Surgeons was used as a baseline for comparison. There was huge variation in the detail and specification of the three specialties' curricula: plastics covered 11/11 of the assessed procedures, while OMFS and otolaryngology covered 7/11 And 4/11, respectively. A total of 45 trainees provided feedback and there was an overall consensus that more training in aesthetics would be beneficial, though accessibility to resources would be an issue. With input from the BAOMS aesthetics lead, our ambitious curriculum increases the number of logbooks to reflect our expertise in the head and neck. It also broadens the span of training over all years of specialist training and, most importantly, relaxes the criteria for transferrable skills. Embracing aesthetics as part of the core curriculum will be beneficial for the future of OMFS, and will produce more rounded surgeons at the end of training. Even the most optimistic observers cannot ignore the financial and logistical setbacks that will have to be faced to achieve this, but we hope that this paper will stimulate a discussion.

Are routine microbiological investigations indicated in the management of non-perianal cutaneous abscesses?

BACKGROUND: It is common practice to take a specimen of pus for microscopy and bacterial culture during drainage of abscesses. The aim of this study was to determine if routine culture and sensitivity had any therapeutic value in the care of patients with non-perianal cutaneous abscesses. PATIENTS AND METHODS: A retrospective analysis ofall patients undergoing drainage ofa cutaneous abscess during a two year period (June 2003 - June 2005) was performed. Patients were identified from the hospital database and theatre records, and those with perianal, pilonidal or surgical wound sepsis were excluded. Notes were reviewed for clinical details, culture results, subsequent admissions and attendance at follow-up. RESULTS: Of the 239 patients treated during this period, 74 patients had 77 operations to drain abscesses that matched the inclusion criteria. Specimens were sent from 52 (67.5%) procedures. Only 65.4% had an organism identified, of which methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism (36.5%). Forty-one point six per cent of patients received antibiotics as part of their treatment. The results of the bacterial culture and antibiotic sensitivities were not known prior to discharge of any patient. CONCLUSION: This study shows that bacteriology swabs are frequently taken during incision and drainage of non-perianal cutaneous abscesses and had little impact on the subsequent treatment, though these results may not be applicable to immune-compromised patients.

Human papillomavirus (HPV) and its vaccine: awareness and opinions of clinical dental students in a UK dental school.

Introduction: Dental clinicians are in a position to educate their patients on the subject of HPV as part of a primary healthcare multidisciplinary team and to detect HPV-related disease. Attention needs to be paid to dental undergraduate teaching on the topic. This study aims to ascertain awareness and opinions of our dental undergraduate students about HPV, its relation to oral health and its vaccine. Method: A questionnaire was distributed to undergraduate dental students in clinical years 3, 4 and 5 of the BDS programme at Bristol Dental School. Results: Dental students demonstrated an understanding of HPV and oropharyngeal cancer and expressed that they felt dentists should play a role in health promotion in relation to oropharyngeal cancers. They also wished for more teaching on the subject and suggested topic areas that they wished to know more about. Conclusion: New teaching strategies on the topic of HPV should be considered for inclusion into undergraduate dental programmes and encompass both knowledge and communication skills training to prepare future dentists for their role in confronting this preventable disease.

Can UK undergraduate dental programmes provide training in non-surgical facial aesthetics?

Aim Recently, more and more dentists have found themselves engaging in the delivery of non-surgical facial aesthetics (NSFA) as part of their regular practice routine. NSFA is a growing field in aesthetic medicine that is practised by a range of clinicians including doctors, dentists and registered prescriber nurses and is an industry estimated to be worth over £3 billion in the UK alone. In the past few years, several public scandals in aesthetic medicine have prompted reactions by several bodies including the Government and Royal Colleges. With Health Education England (HEE) having recently released standards in education, it is clear that a shift in attitude towards training is imminent. With a large volume of dentists making up this NSFA workforce it is reasonable to consider the stance of undergraduate training and the relevance of the existing knowledge within dentistry in the context of the HEE standards.Method All dental schools in the UK were contacted to establish the range of subjects taught within the curriculum, with particular reference to those relevant to NSFA. The two largest aesthetic pharmacies were contacted regarding numbers of registered dentists they serve.Results Twelve out of 16 dental schools responded. Two-thirds of responding dental schools do not cover NSFA in their curricula. However, many dental schools cover related subjects including: facial anatomy/material science/neuromuscular junction physiology (100%), anatomy of the aging face (66%), pharmacology of botulinum toxin (25%) and ethical-legal implications of aesthetic dentistry/NSFA (50%/42% respectively).Conclusion Dentists are well placed to deliver NSFA given their background in relevant subjects and surgical training. With the emergence and growth of such a large multi-disciplinary field it is crucial that dentistry is not left behind. Just as most dental schools have embraced the evolution of cosmetic dentistry and implantology, it would be prudent to consider that training standards around NSFA are reflected in both undergraduate curricula and appropriate post-graduate clinical training for dentistry.

Academic background of oral and maxillofacial specialty trainees in the United Kingdom.

INTRODUCTION: The academic profile of a specialty can be measured in a number of ways. In the selection process for entry into higher training in oral & maxillofacial surgery (OMFS) and for interface fellowships in surgery trainees are awarded points for papers published, presentations, teaching and learning, grants and higher degrees. General information about career development can provide trainers, and trainees, with information and guidance. METHODS: A web-based questionnaire was developed and distributed via electronic mailing lists to all OMFS specialist trainees. Basic demographic information was collected. Previous, current and future career plans were questioned, as was academic background in terms of publications, presentations, prizes and research grants as well as further degrees and examinations. RESULTS: One hundred and five OMFS specialty registrar trainees (StR) replied (76.6% response rate). 83.3% were male and the average age of all trainees was 37 years old. 74.7% obtained a training post on the first application. 62.6% of trainees were keen to practice in trauma surgery. 76.6% were keen to undertake a fellowship. 20.9% were keen to be involved in academia (teaching) and 9.9% in academia (research). 22.1% of trainees had obtained grants. CONCLUSION: Those involved in appointing to training programmes will now be able to see the level of competition. Future applicants to training programmes in oral and maxillofacial surgery in the United Kingdom are now aware of the level of competition. OMFS is not immune to the 'academic crisis' that exists in other surgical specialties, and the completion of higher degrees and entry in to academic careers should be encouraged and supported among trainees with an interest.

Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 1: dental foundation training.

Dental foundation training (DFT) is a two-year programme being introduced for new dental graduates. It is not currently compulsory but there are plans to make it so. Those studying oral and maxillofacial surgery (OMFS) must complete both medical and dental degrees, and training, and if DFT becomes a requirement for dental registration, the process could be lengthened. We aimed to examine the overlap between DFT and medical foundation and core surgical training, to highlight areas of potential duplication for those who completed their surgical training before graduating from dental school. Relevant curricula for OMFS trainees were identified and compared with the DFT curriculum, and a qualitative assessment tool was developed to measure overlap between non-analogous curricula. Depending on previous experience, an OMFS trainee who completed core training in surgery before studying dentistry may already have covered 76% of the DFT curriculum. Areas with the least duplication in clinical skills (53%) were notably those related to restorative dentistry, prosthodontics, and periodontology, but there was considerable overlap in non-clinical areas such as communication skills (100%) and professionalism (90%). A method of standardised assessment of previous experience may allow for DFT to be shortened for OMFS trainees.

Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 2: oral surgery.

A comparison between the curricula for specialist training in oral surgery (OS), and oral and maxillofacial surgery (OMFS) illustrates the overlap between the two specialties. We identified and compared relevant curricula for OMFS with competencies in the OS specialist-training curriculum using a qualitative assessment to establish the degree of overlap. All competencies within the OS curriculum are covered by OMFS curricula, and 21 of 96 OMFS clinical competencies are covered by OS core competencies. The majority of OMFS competencies are unique and are not directly comparable with those in the OS curriculum. Knowledge of this overlap may help to avoid unnecessary duplication in the training of those who wish to transfer specialty.

Radiology trainees in the UK and Ireland: academic background, publication rates and research plans.

To assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 240 radiology trainees in the UK and Ireland. All radiology trainees in the UK and Ireland were surveyed by a questionnaire enquiring about academic record and career ambitions. Our study shows that the level of academic achievement of radiology trainees is high, and provides interesting information concerning the current group of radiology trainees in these regions. It will be of interest both to radiology trainers and to doctors hoping to pursue a career in radiology. It also demonstrates that a potential recruitment crisis in academic radiology exists.

The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004.

OBJECTIVES: This study aimed at investigating aspects of the epidemiology and chronobiology of emergency admissions with epistaxis in Scotland between 1995 and 2004. In particular, we sought to examine the epidemiology of hospital admission with epistaxis and effects of factors such as day of week, time of year and lunar cycle. DESIGN: A statistical analysis, in terms of descriptive statistics, logistical regression and linear regression, was carried out on data obtained from the Scottish Morbidity Records related to emergency Ear, Nose and Throat (ENT) admissions. SETTING AND PARTICIPANTS: All emergency inpatient admissions for Scottish residents to ENT wards in Scottish NHS hospitals during the 10-year period, between 1st January 1995 and December 31st 2004 were studied. This study only looked at admissions and thus excludes Accident and Emergency attendances caused by epistaxis. MAIN OUTCOME MEASURES: Age, gender, year, month and day of the week of admission were considered, as was relationship to the moon phase. RESULTS: During the study period, the mean daily admission rate with epistaxis was six. Epistaxis accounted for 33% of all ENT emergency admissions. The average age of non-epistaxis ENT emergency admission was 31 years. For epistaxis emergency admissions the median age was 70 years. There were fewer admissions in the summer months [August RR: 0.59 (95% CI: 0.54-0.65) P < 0.001]. There were more admissions at the weekends and on non-weekend public holidays [RR: -0.115 (95% CI -0.160-0.071) P < 0.001]. There was a trend towards a reduction in admission rates from the year 2001. Despite the fluctuations with season and weekday, there was no relationship with phase of the moon [RR: 0.98 (95% CI: 0.88-1.09) for day of the full moon compared with non-full moon weekday]. CONCLUSIONS: This study underlines the importance of epistaxis as the single most frequent emergency diagnosis in ENT. The frequency and patterns of admission show pronounced fluctuations. The observed increase in winter admissions confirms earlier work and may have implications for health resource allocation. Relationships between weekends/public holidays and increased admissions with epistaxis may correspond with social patterns of alcohol use (a known aetiological factor). The lunar cycle does not have an effect on the frequency of epistaxis admissions.